High blood pressure treatment

High blood pressure, also known as hypertension, is when the blood in your arteries is being pumped around at too high a pressure.

It’s normal for your blood pressure to change throughout the day and be higher at times, but you’re classed as having high blood pressure when it’s consistently high.

High blood pressure is a common condition, affecting 30% of adults and up to 60% of adults aged 65 and older.

Measuring blood pressure

Blood pressure is measured using a cuff fitted around the arm that is inflated and then gradually deflated to measure the pressure.

A reading will be displayed as 2 different numbers. The systolic pressure is the number on top, which measures the pressure when the heart pumps, and the diastolic pressure is the number at the bottom that measures the pressure when the heart relaxes.

When measured in a clinic setting, a normal blood pressure reading is less than 140/90mmHg – but the cut-off may be higher in people older than 80. If either the higher or the lower number is above this cutoff over a prolonged period, you have high blood pressure.

What causes high blood pressure?

High blood pressure happens when the arteries become stiff, narrow or damaged, making them less stretchy and able to deal with changes in blood flow.

This allows fat to build up in the arteries, narrowing them even further and increasing the risk of conditions like a stroke or heart attack.

There isn’t always a clear reason as to why the arteries narrow and stiffen in this way, but certain things are known to increase the risk, such as:

• smoking
• alcohol
• too much salt
• lack of exercise
• being overweight
• being older
• other people in your family having high blood pressure

You might need high blood pressure treatment if:

1. Your blood pressure is higher than 160/100mmHg.
2. Your blood pressure is persistently between 140/90 and 160/100mmHg AND you have 1 or more of the following:

• kidney disease
• diabetes
• evidence that high blood pressure has damaged one of your organs
• cardiovascular disease (like angina or if you’ve had a heart attack or stroke)
• at least a 10% risk of developing cardiovascular disease in the next 10 years (calculated using a special tool by your GP)

With a blood pressure reading of 140/90mmHg or just below, you may be asked to cut down on things like salt, alcohol, and smoking before using medication.

Exercising regularly can also help to reduce blood pressure. Even if you are prescribed high blood pressure medication, you’ll still be asked to follow appropriate lifestyle changes.

How to check your blood pressure

There are a few ways to check your blood pressure, including:

• buying a machine to use at home
• at your GP or in the hospital during an appointment
• getting a free blood pressure check in a pharmacy

In some cases, it can be better to check your blood pressure at home because some people find their blood pressure is abnormally high when they’re in hospital due to stress.

Even if your blood pressure reading is high in the clinic, you may still need to record your readings at home to make sure the result is not a one-off.

You can discuss your blood pressure readings with a doctor or nurse, and they can advise you on what to do next if your blood pressure is high, including the different blood pressure treatments available.

Blood pressure treatments work by reducing the force of blood pumping through the arteries and limiting your risk of organ damage due to the high pressure.

There are different types of blood pressure medications that work in a variety of ways. Some act on the hormones that control blood pressure, while others remove excess fluid, and others act directly on the artery walls.

Blood pressure medication is usually taken as a daily tablet. Although 1 blood pressure medication is often enough to get high blood pressure under control, some people need to take 2 or more medications to reduce their blood pressure.

How long does it take for high blood pressure treatment to work?

The medication starts working from when you begin taking it, but it may take anywhere from hours to weeks before you will notice a significant difference in your blood pressure.

You will generally need to take blood pressure medication long-term, often for life. Otherwise, once you stop taking the medication, your blood pressure will increase again.

There are 4 main types of blood pressure medications, with some extra medications that are used in certain circumstances (like during pregnancy or if other medications have not worked).

Angiotensin-converting enzyme (ACE) inhibitors

These drugs work by targeting the hormones that control blood pressure, causing the blood vessels to relax and therefore reducing pressure.

ACE inhibitors are usually drugs that end in “pril”, and the following are available from ZAVA:

• ramipril
• lisinopril
• enalapril
• perindopril

ACE inhibitors are an effective blood pressure medication and are a first-line treatment for most adults under 55 or if you have a diagnosis of type 2 diabetes.

How effective are ACE inhibitors?

For example, ramipril is effective in approximately:

• 85% of people with mild to moderate hypertension
• 40% of people with severe hypertension – while this may seem low, it’s common that severe hypertension requires more than 1 treatment option, and effectiveness is increased when taken alongside other medications

Enalapril studies found it to be effective in 88%, 50%, and 25% of people with mild, moderate, and severe hypertension, respectively.

How long do ACE inhibitors take to work?

ACE inhibitors should start to work within a few hours. Lisinopril, one of the most commonly prescribed ACE inhibitors, reaches its peak at approximately 7 hours.

They must be taken every day, and it will take a few weeks to see their full effects. That’s because it takes time for the medication to build up in your system and continuously lower your blood pressure.

How to take ACE inhibitors

ACE inhibitors are usually a tablet that’s taken daily, and the dose depends on the specific medication you’re taking. If you feel dizzy after taking the medication, it may be better to take it in the evenings.

Angiotensin receptor blockers (ARBs)

ARBs work by stopping a hormone called ‘angiotensin II’ from binding to its receptors. By doing this, it causes your blood vessels to relax and widen, reducing blood pressure.

ARBs work similarly to ACE inhibitors, so they cannot be taken together, but they may be an alternative if ACE inhibitors have caused you side effects.

These drugs end with “artan”, and the following are available from ZAVA:

• losartan
• irbesartan
• candesartan (Amias)

ARBs are also a first-line treatment for most adults under 55 years old and are an effective treatment.

How effective are ARBs?

A large-scale comparative study comparing ACE inhibitors and ARBs for hypertension found that ARBs are just as effective as ACE inhibitors and present a ‘better safety profile’, meaning they cause fewer side effects.

A study into the ARB candesartan found that it reduced systolic blood pressure by:

• 6.0mmHg at 4mg
• 9.6mmHg at 8mg
• 12.4mmHg at 16mg

How long do ARBs take to work?

Although these medications will start working shortly after taking them, similarly to ACE inhibitors, it will take a few weeks to see their full effects. For example, losartan studies show a reduction in blood pressure 5 to 6 hours post-dose, and significant reductions after 12 weeks of treatment.

How to take ARBs

Although the dose depends on which ARB you’re prescribed, they’re usually taken as a daily tablet, swallowed whole.

Calcium channel blockers (CCBs)

Calcium channel blockers (CCBs) lower your blood pressure by relaxing the muscular walls of your arteries.

All muscles, including your arteries, need calcium to contract. When calcium enters your arteries they tighten up, making the arteries narrower and increasing blood pressure. CCBs limit the amount of calcium that can enter your arteries, allowing them to relax and widen, which improves blood flow and lowers blood pressure.

This category of medications tends to end in “pine”, and the following treatments in this category are available at ZAVA:

• amlodipine
• lercanidipine
• felodipine
• nifedipine (Adalat)

CCBs are another first-line treatment in adults aged 55 and over, and younger adults of an Afro-Caribbean or Black African ethnicity.

How effective are CCBs?

Studies show CCBs lower blood pressure effectively over a 24-hour period compared to many other types of hypertension medication, including diuretics and beta blockers.

A study looking into amlodipine for hypertension reported an average blood pressure reduction after 24 hours of -12%/–14% (systolic/diastolic).

How long do CCBs take to work?

CCB medications start working within a few hours of being taken, but can take a bit longer to reach their full effect. For example, amlodipine reaches its peak in your body between 6 and 12 hours post-dose. Most people see significant reductions in blood pressure within 24 hours, but it works best when taken long-term.

How to take CCBs

These medications are mostly taken as a daily tablet. Avoid taking CCBs with grapefruit or grapefruit juice, as this can interfere with how the body processes the medication, meaning you may be exposed to too large a dose.

Thiazide diuretics

Thiazide diuretics work by helping to remove water from blood (and other areas of the body). This reduces the pressure on the artery walls as there is less fluid in your bloodstream.

These medications end in “ide”, and ZAVA currently prescribe the following:

• bendroflumethiazide
• indapamide

Thiazide diuretics are effective for treating high blood pressure and are often used if an ACE inhibitor, ARB, or CCB medication has not worked.

How effective is this treatment?

In a meta-analysis comparing 60 different studies into thiazides for hypertension, the average blood pressure reduction was -9mmHg/-4mmHg (systolic/diastolic).

How long do these treatments take to work?

Thiazide diuretic medications start working within a few hours, and you will usually notice a drop in blood pressure within a few days.

How to take these treatments

Thiazide diuretics are usually taken as a once-daily tablet, but are sometimes split into 2 doses. They’re usually taken in the morning, otherwise, they can make you need to go for a wee in the night.

Alternative treatments

Alternative high blood pressure treatments are typically prescribed if:

• other medications have not worked
• you need an extra tablet alongside your regular one to control your blood pressure
• other blood pressure tablets are unsuitable, such as due to allergies, medical history, or other medications you’re taking

Beta blockers

Atenolol and bisoprolol are available from ZAVA, and they belong to a medication class known as beta blockers. These work by reducing how hard and fast the heart pumps.

Alpha blockers

Doxazosin is an alpha blocker available at ZAVA, and is used to treat high blood pressure and an enlarged prostate. It works by preventing a hormone called norepinephrine from narrowing the muscles around your blood vessels – helping them to widen and relax.

What’s the best treatment for high blood pressure?

The best high blood pressure treatment depends on a few different things, including:

• age
• ethnicity
• underlying medical conditions
• other medications someone takes
• preference

Usually, the first-line treatment for adults under 55 who are not of African or Caribbean origin is ACE inhibitors or ARBs. Adults of any age with type 2 diabetes will also usually be given ACE inhibitors or ARBs.

For adults over 55 or under 55 who are of African or Caribbean origin, the first-line treatment is usually CCBs.

If you experience side effects or your blood pressure doesn’t respond to this treatment, a healthcare professional will suggest an alternative. You may need to take several medications at once to significantly reduce your blood pressure.

High blood pressure treatment is only available with a prescription. It can be purchased from an online doctor service like ZAVA, or it‘s available from your GP on the NHS.

Can I get high blood pressure treatment online?

Yes, from registered online doctor services like ZAVA. To get high blood pressure treatment from us, you must have already been diagnosed with high blood pressure.

Our quick and easy online doctor service provides a convenient way of getting a repeat supply of your medication. When you request medication, we will ask you to fill in a brief questionnaire, so our doctor can check whether you can continue your treatment. If suitable, it’ll be sent to your home or can be collected at your local Post Office.

Can I get high blood pressure treatment over the counter?

No, you cannot buy high blood pressure medication over the counter, but you can buy it from an online or high street pharmacy with a prescription.

Can I get high blood pressure treatment on the NHS?

Yes, medication for high blood pressure can also be accessed through the NHS, via your GP or directly from the hospital in some cases. However, you may have fewer choices when getting your high blood pressure treatment on the NHS.

The side effects of your high blood pressure treatment will vary depending on which medication you take.

The most common side effects include:

• coughing
• diarrhoea
• constipation
• feeling or being sick (nausea or vomiting)
• dizziness or fainting
• nervousness
• headaches
• rashes
• weight loss
• tiredness

A full list of the side effects for each medication can be found in the patient information leaflet inside the medication packaging.

Side effects tend to be worse when you first start taking your medication and improve with time as your body gets used to it. If you’re worried about side effects, contact a healthcare professional or call 999 in an emergency.

Don’t stop taking your medication without telling a healthcare professional otherwise your blood pressure will go back up.

Not all high blood pressure medications are suitable for everyone, and some drugs used to treat high blood pressure can interact with other medications or worsen pre-existing health conditions.

You may not be able to take blood pressure medication if you have:

• an allergy to any ingredients in the medication prescribed
• low blood pressure
• kidney or liver problems
• diabetes
• gout
• porphyria, a rare blood disorder
• heart problems
• a history of a heart attack, stroke, or angina
• asthma

Pregnant women should not take ACE inhibitors, ARBs, or thiazide diuretics, and these drugs should be stopped immediately after becoming pregnant. Most tablets cannot be taken if you are pregnant or breastfeeding, so speak to your doctor first.

You should not take any other medication that can lower your blood pressure, unless you have spoken to your doctor first. This includes:

• Viagra (sildenafil)
• some antidepressants
• medication for an enlarged prostate
• Baclofen (a muscle relaxant)

As there are so many different types of blood pressure medication, it’s important to discuss whether a specific medication is safe for you with a healthcare professional.